Page 1 of 79
EMERGENCY/ACUTE CARE EXAM LATEST VERSION
QUESTIONS AND ANSWERS 2026 EDITION
Emergency/Acute Care: 250 Practice Questions with Rationales
DOMAIN 1: TRIAGE AND PRIORITIZATION (25 Questions)
1. A patient presents to the emergency department with chest pain radiating to the
left arm, shortness of breath, and diaphoresis. The Emergency Severity Index (ESI)
triage level should be:
A) ESI Level 1 (immediate life threat)
B) ESI Level 2 (high risk)
C) ESI Level 3 (urgent)
D) ESI Level 4 (semi-urgent)
Answer: B) ESI Level 2 (high risk)
Rationale: This patient has a high-risk presentation consistent with acute coronary
syndrome. ESI Level 1 is reserved for imminent life threats (cardiac arrest, severe
respiratory distress, unresponsiveness). Level 2 is for patients who are high risk but not
currently in extremis. The patient is awake and breathing, so Level 1 is not appropriate .
2. The highest priority in emergency care according to the ABCDE framework is:
A) Circulation
B) Disability
C) Airway with cervical spine protection
D) Exposure
Answer: C) Airway with cervical spine protection
Rationale: The ABCDE framework prioritizes: A = Airway with cervical spine protection, B
= Breathing, C = Circulation, D = Disability (neurologic status), E =
, Page 2 of 79
Exposure/environmental control. Airway is always the first priority in any emergency
assessment .
3. A patient who is unable to speak in full sentences, using accessory muscles to
breathe, and has an SpO2 of 88% should be triaged as:
A) ESI Level 1 (immediate life threat)
B) ESI Level 2 (high risk)
C) ESI Level 3 (urgent)
D) ESI Level 4 (semi-urgent)
Answer: A) ESI Level 1 (immediate life threat)
Rationale: This patient is in severe respiratory distress with accessory muscle use,
inability to speak in full sentences, and significant hypoxia (SpO2 <92%). These findings
indicate an immediate life threat requiring immediate intervention. This patient meets
criteria for ESI Level 1 .
4. A patient with a witnessed seizure that has stopped but remains postictal and
confused should be triaged as:
A) ESI Level 1
B) ESI Level 2
C) ESI Level 3
D) ESI Level 4
Answer: B) ESI Level 2
Rationale: A patient who has had a seizure and remains postictal is high risk but not
currently in extremis. ESI Level 2 is appropriate. ESI Level 1 would be for a patient
actively seizing with respiratory compromise or in status epilepticus .
5. The first step in managing any emergency patient is:
A) Obtaining IV access
B) Performing a focused history
C) Assessing and maintaining airway, breathing, and circulation
D) Obtaining vital signs
Answer: C) Assessing and maintaining airway, breathing, and circulation
, Page 3 of 79
Rationale: The primary survey (ABCDE) is the first step in emergency management.
Airway, breathing, and circulation must be assessed and stabilized before any further
assessment or treatment .
6. The initial step in evaluating any patient with a chief complaint of chest pain is:
A) Obtain a 12-lead ECG
B) Check cardiac enzymes
C) Assess the patient's airway, breathing, and circulation
D) Administer aspirin
Answer: C) Assess the patient's airway, breathing, and circulation
Rationale: The ABCDE approach is always the first priority. Even with a patient who is
stable and talking, you must first ensure the airway is patent, breathing is adequate, and
circulation is intact before performing a 12-lead ECG .
7. Which of the following patients should be seen first in the emergency
department?
A) A 45-year-old with chest pain and diaphoresis
B) A 30-year-old with a sprained ankle
C) A 65-year-old with a urinary tract infection
D) A 25-year-old with a sore throat
Answer: A) A 45-year-old with chest pain and diaphoresis
Rationale: Chest pain with diaphoresis is a high-risk presentation that could indicate
acute coronary syndrome. This patient requires immediate evaluation and should be
prioritized over patients with non-urgent or low-acuity conditions .
8. The Emergency Severity Index (ESI) is a triage system that assigns patients to
levels based on:
A) Age and gender
B) Chief complaint and vital signs
C) Acuity and resource needs
D) Insurance status
Answer: C) Acuity and resource needs
, Page 4 of 79
Rationale: The ESI triage algorithm assigns patients to levels 1-5 based on acuity (need
for immediate life-saving intervention) and resource needs (number of expected
resources). It is a five-tier system widely used in emergency departments.
9. A patient who requires immediate life-saving intervention (e.g., intubation, CPR)
should be assigned which ESI level?
A) Level 1
B) Level 2
C) Level 3
D) Level 4
Answer: A) Level 1
Rationale: ESI Level 1 is for patients who require immediate life-saving intervention.
These patients are in extremis and cannot wait for care. Level 2 is for high-risk patients
who are not currently in extremis but require urgent evaluation.
10. A patient with a chief complaint of "I feel like I'm going to pass out" and vital
signs showing HR 130, BP 85/50 should be triaged as:
A) ESI Level 1
B) ESI Level 2
C) ESI Level 3
D) ESI Level 4
Answer: A) ESI Level 1
Rationale: This patient is in decompensated shock (tachycardia, hypotension, and
symptoms of inadequate perfusion). This is an immediate life threat requiring rapid
intervention. Level 1 is the appropriate triage level .
11. The first priority in the primary survey of a trauma patient is:
A) Breathing
B) Circulation
C) Airway with cervical spine immobilization
D) Disability
Answer: C) Airway with cervical spine immobilization
EMERGENCY/ACUTE CARE EXAM LATEST VERSION
QUESTIONS AND ANSWERS 2026 EDITION
Emergency/Acute Care: 250 Practice Questions with Rationales
DOMAIN 1: TRIAGE AND PRIORITIZATION (25 Questions)
1. A patient presents to the emergency department with chest pain radiating to the
left arm, shortness of breath, and diaphoresis. The Emergency Severity Index (ESI)
triage level should be:
A) ESI Level 1 (immediate life threat)
B) ESI Level 2 (high risk)
C) ESI Level 3 (urgent)
D) ESI Level 4 (semi-urgent)
Answer: B) ESI Level 2 (high risk)
Rationale: This patient has a high-risk presentation consistent with acute coronary
syndrome. ESI Level 1 is reserved for imminent life threats (cardiac arrest, severe
respiratory distress, unresponsiveness). Level 2 is for patients who are high risk but not
currently in extremis. The patient is awake and breathing, so Level 1 is not appropriate .
2. The highest priority in emergency care according to the ABCDE framework is:
A) Circulation
B) Disability
C) Airway with cervical spine protection
D) Exposure
Answer: C) Airway with cervical spine protection
Rationale: The ABCDE framework prioritizes: A = Airway with cervical spine protection, B
= Breathing, C = Circulation, D = Disability (neurologic status), E =
, Page 2 of 79
Exposure/environmental control. Airway is always the first priority in any emergency
assessment .
3. A patient who is unable to speak in full sentences, using accessory muscles to
breathe, and has an SpO2 of 88% should be triaged as:
A) ESI Level 1 (immediate life threat)
B) ESI Level 2 (high risk)
C) ESI Level 3 (urgent)
D) ESI Level 4 (semi-urgent)
Answer: A) ESI Level 1 (immediate life threat)
Rationale: This patient is in severe respiratory distress with accessory muscle use,
inability to speak in full sentences, and significant hypoxia (SpO2 <92%). These findings
indicate an immediate life threat requiring immediate intervention. This patient meets
criteria for ESI Level 1 .
4. A patient with a witnessed seizure that has stopped but remains postictal and
confused should be triaged as:
A) ESI Level 1
B) ESI Level 2
C) ESI Level 3
D) ESI Level 4
Answer: B) ESI Level 2
Rationale: A patient who has had a seizure and remains postictal is high risk but not
currently in extremis. ESI Level 2 is appropriate. ESI Level 1 would be for a patient
actively seizing with respiratory compromise or in status epilepticus .
5. The first step in managing any emergency patient is:
A) Obtaining IV access
B) Performing a focused history
C) Assessing and maintaining airway, breathing, and circulation
D) Obtaining vital signs
Answer: C) Assessing and maintaining airway, breathing, and circulation
, Page 3 of 79
Rationale: The primary survey (ABCDE) is the first step in emergency management.
Airway, breathing, and circulation must be assessed and stabilized before any further
assessment or treatment .
6. The initial step in evaluating any patient with a chief complaint of chest pain is:
A) Obtain a 12-lead ECG
B) Check cardiac enzymes
C) Assess the patient's airway, breathing, and circulation
D) Administer aspirin
Answer: C) Assess the patient's airway, breathing, and circulation
Rationale: The ABCDE approach is always the first priority. Even with a patient who is
stable and talking, you must first ensure the airway is patent, breathing is adequate, and
circulation is intact before performing a 12-lead ECG .
7. Which of the following patients should be seen first in the emergency
department?
A) A 45-year-old with chest pain and diaphoresis
B) A 30-year-old with a sprained ankle
C) A 65-year-old with a urinary tract infection
D) A 25-year-old with a sore throat
Answer: A) A 45-year-old with chest pain and diaphoresis
Rationale: Chest pain with diaphoresis is a high-risk presentation that could indicate
acute coronary syndrome. This patient requires immediate evaluation and should be
prioritized over patients with non-urgent or low-acuity conditions .
8. The Emergency Severity Index (ESI) is a triage system that assigns patients to
levels based on:
A) Age and gender
B) Chief complaint and vital signs
C) Acuity and resource needs
D) Insurance status
Answer: C) Acuity and resource needs
, Page 4 of 79
Rationale: The ESI triage algorithm assigns patients to levels 1-5 based on acuity (need
for immediate life-saving intervention) and resource needs (number of expected
resources). It is a five-tier system widely used in emergency departments.
9. A patient who requires immediate life-saving intervention (e.g., intubation, CPR)
should be assigned which ESI level?
A) Level 1
B) Level 2
C) Level 3
D) Level 4
Answer: A) Level 1
Rationale: ESI Level 1 is for patients who require immediate life-saving intervention.
These patients are in extremis and cannot wait for care. Level 2 is for high-risk patients
who are not currently in extremis but require urgent evaluation.
10. A patient with a chief complaint of "I feel like I'm going to pass out" and vital
signs showing HR 130, BP 85/50 should be triaged as:
A) ESI Level 1
B) ESI Level 2
C) ESI Level 3
D) ESI Level 4
Answer: A) ESI Level 1
Rationale: This patient is in decompensated shock (tachycardia, hypotension, and
symptoms of inadequate perfusion). This is an immediate life threat requiring rapid
intervention. Level 1 is the appropriate triage level .
11. The first priority in the primary survey of a trauma patient is:
A) Breathing
B) Circulation
C) Airway with cervical spine immobilization
D) Disability
Answer: C) Airway with cervical spine immobilization
